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Male Hormone Questionnaire

Do you experience ...

[ ] Weight loss
[ ] Hair loss
[ ] Loss of sex drive
[ ] Loss of muscle mass
[ ] Gallbladder problems
[ ] Puffiness / bloating
[ ] Fatigue
[ ] Prostate enlargement
[ ] Irritability
[ ] Enlarged breasts
[ ] Lower stamina
[ ] Weight gain
[ ] Softer erections
[ ] Headaches
[ ] Breast enlargement

If you checked more than 3 boxes, you may be experiencing symptoms related to hormonal imbalances.

 
       

Sharon Krahn, LLC
Ph: 214-352-7546
Fax: 214-353-8500
Email: Sharon Krahn
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This page last updated 11/23/12